CONTENTS
Chapters
- The Toll of STDs
- Reducing the Toll of STDs
- Managing STDs
- Diagnostic and Treatment Tips
- Getting Services to the People
- Getting People to Services
- Promoting Prevention—Condoms and Monogamy
HIGHLIGHTS
Population Reports is published by the Population Information Program, Center for Communication Programs, The
Johns Hopkins School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland
21202-4012, USA
Volume XXI, Number 1
June, 1993 |
Vaginal Discharge
Diagnostic Tips
- The perception of abnormal vaginal discharge depends on
the patient. Common complaints are new or increasing
stains on underwear, a large volume of secretions,
change in the color or consistency of the discharge, a
foul odor, itching and soreness, painful urination, or
pain during intercourse.
- The risk assessment questions, shown in the flow chart,
help to distinguish sexually transmitted infections
from reproductive tract infections that are not
sexually transmitted. Bacterial vaginosis and
candidiasis are usually not sexually transmitted. They
can be caused by an overgrowth of organisms that are
normally in the vagina.
- Diagnosing an STD on the basis of the consistency of
vaginal discharge may be difficult. If a diagnosis
cannot be based on the consistency of the discharge,
check the pH of the discharge if possible. Normal
vaginal fluid has a pH between 4.0 and 4.5. Bacterial
vaginosis raises the pH above 4.5. In candidiasis the
pH of the discharge is usually less than 4.5.
Trichomoniasis discharge usually has a pH greater than
5.0 (283). Blood in vaginal secretions or pregnancy
also may make the pH greater than 4.5, however.
- Check the appearance of the vagina and vulva. If they
are inflamed, candidiasis or trichomoniasis may be the
cause. Bacterial vaginosis usually does not cause
inflammation (121).
- Vulvar itching is also a symptom of candidiasis and
trichomoniasis (121).
- The origin of the discharge can help to identify the
disease. Discharge from the cervix indicates possible
gonorrheal or chlamydial infection. Discharge from the
vaginal wall indicates trichomoniasis, candidiasis, or
bacterial vaginosis. Trichomoniasis also can cause
urethral discharge. Identifying the origin of discharge
in the vagina may be difficult, however. Wiping off the
cervix with a swab can help. Discharge from the cervix
may then be observed. Other signs of cervical infection
are redness and bleeding when the cervix is touched
with a swab.
- Check the patient for lower abdominal pain by doing a
bimanual exam, if possible. If moving the cervix causes
pain, use the flow chart for lower abdominal pain
(325).
- Take the patient's temperature if possible. If the
patient has a fever, use the flow chart for lower
abdominal pain (325).
- Patients who return often with candidiasis may have HIV
infection or diabetes (306). Refer them to a hospital
for testing.
Treatment Tips
- Treat male partners of women with trichomoniasis by
using metronidazole, 2 g in one oral dose, or 400-500
mg orally, two times daily for seven days (185).
- Metronidazole crosses the placenta and may slightly
increase the risk of congenital malformation. It should
not be given to women in the first trimester of
pregnancy. Since there are no other effective
treatments for trichomoniasis, metronidazole may be
used during the second and third trimesters if
necessary (169, 248).
- Metronidazole passes into breast milk. Some think that
breastfeeding women given the single 2 g oral dose
should interrupt breastfeeding for 24 hours (169, 325).
Women may not need to stop breastfeeding, however,
because there is no evidence that metronidazole is
harmful to babies (272), whereas disrupting
breastfeeding could be harmful.
- If a speculum is available, examine patients to judge
whether the discharge has diminished. Without a
speculum, rely on the patients' judgment.
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